If Marylanders really fear cancer and want to reverse the state's cancer death rate -- the nation's highest -- they're going to have to take personal responsibility, says a Johns Hopkins School of Public Health expert.
The high incidence rate and mortality of lung cancer will decrease only when men and women give up smoking, Dr. Genevieve Matanoski, a professor of epidemiology, stressed yesterday.
But, since the causes of breast, colon and prostate cancer are not so clear, Matanoski said, people are going to have to be screened for early signs of these big killers of Marylanders and "that's something they're going to have to do every year over their lifetime."
The pattern of risk in Maryland is a little different than in other states, said Matanoski, a panelist in the first of a series of four Preventive Medicine Grand Rounds sponsored by the Johns Hopkins Preventive Medicine Residency Program.
The discussions, free and open to the public, are intended to inspire civic action on pressing public health problems.
"[Maryland's] first not because we've got a lot of any one disease or any two diseases, but because we're up in the top ranks of lung, breast, colon and prostate cancer," said Matanoski, who also serves on Maryland's new Council on Cancer Control.
. "The only other state that is even similar to us is Delaware," she said, "which comes straight after us."
Maryland has the highest overall cancer mortaliy rate of any state in the nation, 194 deaths per 100,000 residents, compared to 171 per 100,000 for the United States. Delaware, in second place, has 189 deaths per 100,000 cases.
Some 9,000 people die from cancer each year in Maryland.
Maryland has high death rates for all of the most common cancers.
Its death rate for lung cancer is the fifth highest in the nation; for colon cancer, third highest; for breast cancer, seventh highest; and for prostate cancer, fifth highest. These cancers cut across all age, race, sex and socioeconomic levels, statistics show.
Matanoski said that no one is absolutely sure why Maryland has high death rates for the most common cancers, but she believes they're tied to a migration to Maryland of people from both north and south, all of whom have brought with them lifestyles that are risks for cancer.
In making her comments, Matanoski answered one of the questions that Gov. William Donald Schaefer -- in his "call to action" to the 200 people present -- said was bothering him the most.
"Why is Maryland number one in the country in cancer deaths?" Schaefer asked. "I can't understand this. I go about the state and see its trees, its ocean and its bay. Are they a part of it? Whose fault is it? Are we getting the message of prevention and protection out strongly enough?"
He said that people "are afraid of this unseen, unknown thing" that hits healthy people one day and a few months later they are dying. And he called for "an aggressive, bold plan" that would need support from the National Cancer Institute.
"We need to become a role model and do something that might help our people and then help the world," the governor said.
Matanoski said that Maryland has "a black population that is very high on smoking, and that's one of our biggest problems here."
Matanoski stressed the urgency of an "information center" that would provide the council with the true incidence of cancer in the state. She was referring to a cancer registry, such as the one approved by the state legislature in 1982 but which has never gotten off the ground.
Under expanded legislation that became effective in July, all of Maryland's 54 hospitals, independent laboratories and radiological centers that make initial cancer diagnoses and treat cancer patients have to submit incidence reports to the cancer registry, located at the state health department.
"If you just look at the mortality curve, it dosn't show you much of the impact of the different cancers because people don't always die of the cancer, they frequently live for 20 years and die of something else," Matanoski said.
"What you have to do to see whether you are doing something about the disease is determine what the incidence is -- are we getting rid of some of the cases . . . and this is going to take some time."